This Angel is pissed off. I'm Nurse Anne and I work on large general medical ward in the NHS. These are the wards with the most issues surrounding nursing care. The problems are mostly down to intentional understaffing by hospital chiefs that result in a lack of real nurses on the wards.
"The martyr sacrifices themselves entirely in vain. Or rather not in vain, for they merely make the selfish more selfish, the lazy more lazy and the narrow more narrow"-Florence Nightengale

Saturday, 28 January 2012

Respect the Junior Doctors

I had some real bad days as an NHS staff nurse. I felt like the stress and frustration would kill me. But there was a never a day where I felt like I would rather be a Junior Doctor. Those kids run their asses off.

They often carry the pager for the whole hospital. They are dealing with incredibly complex cases at the same time as routine stuff with nothing more than 5 seconds between bleeps from yet another staff nurse on another ward. We nurses have to call them for a lot of stupid shit as well, because of dumb rules. Some nurses forget that the medic is trying to be 1000 places at once and get impatient and demanding.

I have seen junior doctors collapse in crying fits at the nurse's station, breaking down to the point where they couldn't answer their bleeps. We tried to help the best we could by answering the bleep and telling the caller that the doctor was busy and would get back as soon as he could. We knew that the consultant would show the juniors no mercy and we tried to protect them. Well some of us did. Others were so worn out and mired down in the bullshit clusterfuck that is ward Nursing that they just lashed out as a way to cope. It's like they enjoyed watching other health care professionals squirm and suffer.

Junior doctors would lash out too. But I found that, as a group, they were more of a friend to Registered Nurses than any other health care professional group out there.

Once I made a mistake as a newish nurse (thank god no harm came to the patient). When I realised the mistake, the first thing I did was call the junior doctor on call, who was already very busy I'm sure. He was very kind and reassuring on the phone. He came to my ward straight away and reviewed the patient and then he calmed my anxieties, wiped away my tears and reassured me that everything was fine. He said that he thought what I did may have been good for the patient rather than bad. Those words of encouragement from him helped me to get through the rest of my shift.

In turn I always tried to encourage and reassure the junior doctors whenever I could.

I saw this blog this morning and it reminded me of so many things I saw at work. It's a great read. Have a look at it.

well done girl you done your best and we take our hats of to you and nurses like you most doctors think there gods or better than Gods. we beleave you becouse we have seen it for our selfs how crewl these people can be we have also seen them get away with murder it all wrong its a law for one and a law for another here in the UK

So good to read about nursing from somebody who tells it like it is! I'll be (secretly) pointing new members of our nursing agency here to find out what it's really like - it's tough but caring often is. Keep up the good work and don't let the bastards grind you down!

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Everybody knows that a hospital/ institution follows a staffing hierarchy. Nurses are supervised by doctors and the same thing goes with junior doctors. Remember that this hierarchy gives power to MDs but this power is NOT absolute. Hence, each member of the health team should be given due respect and recognition. Lets us collaborate with and help each other achieve one goal for our patients!

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In an atmosphere if universal deceit telling the truth is a revolutionary act. George Orwell.

Why has Nursing Care Deteriorated

Good nurses are failing every day to provide their patients with a decent standard of care. You want to know what has happened? Read this book and understand that similiar things have happened in the UK. Similiar causes, similiar consequences. And remember this. The failings in care have nothing to do with educated nurses or nurses who don't care. We need more well educated nurses on the wards rather than intentional short staffing by management.

About Me

I am a university educated registered nurse. We had a hell of a lot of hands on practice as well as our academic courses. The only people who say that you don't need a brain or an education to be an RN are the people who do not have any direct experience of nursing in acute care on today's wards. I have yet to meet a nurse who thinks that she is above providing basic care. I work with nurses who are completely unable to provide basic care due to ward conditions.
I have lived and worked in 3 countries and have seen more similarities than differences. I have been a qualified nurse for nearly 15 years. I never used to use foul language until working on the wards got to me. It's a mess everywhere, not just the NHS.
Hospital management is slashing the numbers of staff on the ward whilst filling us up with more patients than we can handle... patients who are increasingly frail. After an 8-14 hour shift without stopping once we have still barely scratched the surface of being able to do what we need to do for our patients.

Quotes of Interest. Education of Nurses.

Hospitals with higher proportions of baccalaureate-prepared nurses tended to have lower 30-day mortality rates. Our findings indicated that a 10% increase in the proportion of baccalaureate prepared nurses was associated with 9 fewer deaths for every 1,000 discharged patients."...Journal of advanced nursing 2007

THIS MEANS WE NEED WELL EDUCATED NURSES AT THE BEDSIDE NOT IN ADVANCED ROLES

Dr. Linda Aiken and her colleagues at the University of Pennsylvania identified a clear link between higher levels of nursing education and better patient outcomes. This extensive study found that surgical patients have a "substantial survival advantage" if treated in hospitals with higher proportions of nurses educated at the baccalaureate or higher degree level.

THIS MEANS WE NEED WELL EDUCATED NURSES AT THE BEDSIDE NOT IN ADVANCED ROLES

Dr. Linda Aiken and her colleagues at the University of Pennsylvania's Center for Health Outcomes and Policy Research found that patients experienced significantly lower mortality and failure to rescue rates in hospitals where more highly educated nurses are providing direct patient care.

Evidence shows that nursing education level is a factor in patient safety and quality of care. As cited in the report When Care Becomes a Burden released by the Milbank Memorial Fund in 2001, two separate studies conducted in 1996 - one by the state of New York and one by the state of Texas - clearly show that significantly higher levels of medication errors and procedural violations are committed by nurses prepared at the associate degree and diploma levels as compared with the baccalaureate level.

Registered Nurse Staffing Ratios

International Council of Nurses Fact Sheet:

In a given unit the optimal workload for a registered nurse was four patients. Increasing the workload to 6 resulted in patients being 14% more likely to die within 30 days of admission.

A workload of 8 patients versus 4 was associated with a 31% increase in mortality. (In the NHS RN's each have anywhere from 10-35 patients per RN. It doesn't need to be this way..Anne)

Registered Nurses in NHS hospitals usually have between 10 and 30+ patients each on general wards.

Earlier in the year, the New England Journal of Medicine published results from another study of similar genre reported by a different group of nurse researchers. In that paper, Needleman et al3 examined whether different levels of nurse staffing are related to a patient’s risk of developing complications or of dying. Data from more than 5 million medical patient discharges and more than 1.1 million surgical patient discharges from 799 hospitals in 11 different states revealed that patients receiving more care from RNs (compared to licensed practical nurses and nurses’ aides) and those receiving the most hours of care per day from RNs experienced fewer complications and lower mortality rates than those who received more of their care from licensed practical nurses and/or aides. Specifically for medical patients, those who received more hours per day of care from an RN and/or those who had a greater proportions of their care provided by RNs experienced statistically significant shorter length of stay and lower complication rates (urinary tract infections, gastrointestinal bleeding, pneumonia, cardiac arrest, or shock), as well as fewer deaths from these and other (sepsis, deep vein thrombosis) complications

•Lower levels of hospital registered nurse staffing are associated with more adverse outcomes such as Pneumonia, pressure sores and death.
•Patients have higher acuity, yet the skill levels of the nursing staff have declined as hospitals replace RN's with untrained carers.
•Higher acuity patients and the added responsibilities that come with them increase the registered nurse workload.
•Avoidable adverse outcomes such as pneumonia can raise treatment costs by up to $28,000.
•Hiring more RNs does not decrease profits. (Hospital bosses don't understand this. They think that they will save money by shedding real nurses in favour of carers and assistants. The damage done to the patients as a result of this costs more moneyi.e expensive deaths, complications,and lawsuits, and complaints....Anne)

Disclaimer

I know I swear too much. I am truly very sorry if you are offended. Please do not visit my blog if foul language upsets you. I want to help people. That is why I started this blog and that is why I became a Nurse. I won't run away from Nursing just yet. I want to stick around and make things better. I don't want the nurses caring for me when I am sick working in the same conditions that I am. Of course this is all just a figmant of my imagination anyway and I am not even in this reality. Or am I?Any opinions expressed in my posts are mine and mine alone and do not represent the viewpoint of the NHS, the RCN, God, or anyone else.